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Headaches May Suggest a More Severe Concussion

13 Jan

Cervical dysfunction is often a cause or contributing factor of headaches, especially those that occur following a sports injury, slip and fall, or motor vehicle collision. The results of a 2019 study suggest that headaches may also indicate when a patient has a severe traumatic brain injury (TBI).

In the study, researchers asked 121 children with a history of TBI to fill out a questionnaire called the Sports Concussion Assessment Tool (SCAT). A higher score on the SCAT is indicative of a more severe TBI. Among the participants, the SCAT revealed that a third (40) reported headaches following their injury. When the researchers compared the SCAT scores of the kids with post-TBI headaches and those without headaches, they found that the participants who experienced headaches scored five times higher (median score 45.5 vs. 9). These children also performed worse on cognitive assessments involving color naming, matrix reasoning, letter sequencing, and letter switching.

The authors concluded that when headaches are associated with TBI, higher symptom scores (i.e. more severe symptoms) for ALL other symptom categories (sleep, mood, sensory, and cognitive domains) can be expected. In addition, those with headaches also tested worse on neurocognitive examinations.

Interestingly, a study that included a wider age range reported that headache “is consistently the most common symptom following concussion and occurs in over 90% of athletes with sport-related concussion,” which is much higher than the 33% found in the above- mentioned study.

Another study that analyzed information from two large databases found that patients who are hospitalized for headache symptoms associated with TBI are two times more likely to experience more frequent or worse headache symptoms over the following decade. Thus, the worse the initial TBI, the more likely headaches will persist or worsen.

These studies suggest that when an individual suffers a TBI from a sports injury, slip and fall, or car accident AND they have headaches, their condition may be more severe and may require more specialized care or intensive treatment to achieve a successful outcome. These injuries can also affect the cervical region, which may explain why patients with TBI benefit from many of the same treatment approaches doctors of chiropractic use to treat whiplash associated disorder patients.

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Spinal Manipulation and Headaches

19 Dec

Cervicogenic headache (CGH) refers to headaches caused by dysfunction in the neck, and experts estimate that 18% of chronic headache patients have cervicogenic headaches. Spinal manipulative therapy (SMT) is a form of treatment most commonly provided by doctors of chiropractic, and several studies have demonstrated that SMT is highly effective for patients suffering musculoskeletal disorders of the neck, including those with cervicogenic headaches. However, there remains little consensus on the appropriate number of SMT treatments to achieve maximum benefits for CGH.

In a 2018 study, a team of researchers conducted a large-scale study involving 256 chronic CGH patients to determine how many treatments are needed to achieve optimum results using SMT for CGH. The investigators randomly assigned participants to one of four dose levels (0, 6, 12, or 18 visits) of SMT for six weeks. The type of SMT consisted of a manual high-velocity, low-amplitude (HVLA) thrust manipulation in the cervical and upper thoracic regions. The location of the spinal adjustment was determined by a brief, standard spinal palpatory examination from the occiput to T3 to assess for pain and restricted motion. For older patients and/or those in acute pain, the manual therapy was modified to a low-velocity, low-amplitude mobilization. To control for visit consistency and provider attention, patients continued to receive a light massage treatment once a patient’s assigned number of visits was satisfied, until the six-week treatment period ended.

After the conclusion of the treatment phase of the study, the participants used a headache diary to keep track of their headaches for the next year. The results showed that the patients who received the most SMT treatments had fewer headaches over the following twelve months. More specifically, the researchers calculated that six additional SMT visits resulted in about twelve fewer days with headaches over the next year.

If you suffer from headaches, consider consulting with a doctor of chiropractic to determine if cervical dysfunction is a potential cause or contributing factor and whether you are a candidate for spinal manipulative therapy.

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Cervical Traction for Neck Pain

18 Nov

In addition to spinal manipulation, doctors of chiropractic often use other conservative therapies to reduce pain and improve function in patients with neck pain. When it comes to neck conditions involving herniated disks, radiating arm pain (“radiculopathy”), strains, facet syndromes or sprains, and myofascial pain, cervical traction is one such option.

As part of the initial new patient examination, a chiropractor may use their hands to gently pull on the patient’s neck while in sitting and/or supine (lying on the back) positions. If this feels good, then cervical traction may be warranted either in the office, with an at-home unit, or both. However, cervical traction is not advised if there is instability in the spine/ligaments, vertebral artery insufficiency, rheumatoid arthritis, osteomyelitis, discitis, neoplasm, severe osteoporosis, untreated hypertension, severe anxiety, cauda equina syndrome, or myelopathy.

There are various forms of cervical traction devices, so treatment may be performed while the patient is in a standing, sitting, lying horizontal, or inclined either prone or supine position, and the traction force can be continuous or sustained vs. intermittent or pulsed. Variables include body/head weight and the associated friction against the traction table in lying down types of units, and the angle can often be varied with most types of traction units.

There are pros and cons to different types of traction units. Lying down traction may allow for better relaxation vs. sitting, but more weight may be needed due to the friction of the body on the table. Generally, when hold times are longer (especially with sustained traction), less weight is used. Some doctors advocate starting at 5 lbs. (~2.67 kg) for 15 minutes with a sitting device (sustained traction) and gradually increasing the weight to maximum tolerance while keeping the time constant at 15 minutes.

There are a number of theories on why traction relieves pain: it forces rest through immobilization and by supporting the weight of the head, it pulls apart or opens the facet joints, it improves nutrition to the joint cartilage, stretches ligaments, it decreases the pressure inside the disks, it reduces pressure on nerve roots (by widening the holes through which they travel), it improves head posture, and/or it stretches the neck muscles to improve blood flow and reduce muscle spasm.

The bottom line, if you have neck pain and manual traction applied to the cervical spine provides pain relief, then your doctor of chiropractic may choose to incorporate this therapy into your treatment plan, either in the office, at home, or both.

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Do Cell Phones Cause Horns?

21 Oct

It’s not hard to argue that nearly everyone spends too much time on their electronic devices, especially smartphones. You may be familiar with the terms “text neck” or “forward head posture”, but have you heard that excessive cellphone use may cause your body to grow horns?

If you reach around to the back of your head, just above the top of the neck, you should feel a bump in the midline. This is NORMAL, and it’s called the external occipital protuberance (EOP). The EOP serves as an attachment point for the nuchal ligament and the trapezius muscle, which function to keep the head upright and tilted backward. The size of the EOP normally varies (averaging around 5mm), depending on race, gender, genetics, and occupation.

A 2016 study revealed that an alarming number of young people had spurs (technically called enthesophytes) extending from the EOP, an occurrence associated with the wear-and-tear of osteoarthritis that can develop later in life. In the study, researchers reviewed x-rays of 218 men and women 18 to 30 years old who either had back pain, neck pain, or headaches or no history of such conditions. The research team observed an enlarged EOP (EEOP for short) in 41% of participants, regardless of the presence or absence of musculoskeletal pain. However, the data did show that EEOP was three-times more common in men than women.

The same study authors conducted a larger study in 2018 that included 1,200 adults of all ages and found that the combination of male gender, the degree of forward head protraction (FHP), and age predicted the presence of EEOP. Their results showed that being a young male with a greater amount of FHP lead to the formation of EEOP.

The researchers suspect that the age component of their finding (after all, the frequency and severity of degenerative skeletal spur formation typically worsen with age) may be due to young adults placing a greater mechanical load on their necks due to forward head posture caused by excessive device use.

The good news is that studies have demonstrated forward head posture can be improved with specific resistance and stretching exercises, monitoring your posture while using electronic devices, and reducing electronic device use. Your doctor of chiropractic can show you exercises that you can perform at home to reduce forward head posture.

 

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Exercise and Posture Training for Neck Pain

16 Sep

A quick look around any airport, mall, or auditorium/theater will reveal that poor posture is common. There’s forward head posture, rolled forward shoulders, and uneven/misaligned heads/shoulders/pelvis-hips. Some people even limp or shuffle while walking. Research shows that when a person adopts an abnormal posture, it can place added strain on various areas of the body, which can elevate the risk for musculoskeletal pain, including neck pain. The good news is that when combined with chiropractic care, at-home exercises are great for improving a patient’s posture, which can also reduce their risk for future episodes of neck pain. Let’s look at some of the studies that support the use of at-home exercise and posture training for neck pain…

  • For older adults with a bent forward posture due to rounding of the mid back (“hyper kyphosis”), a six-month study that included 99 seniors revealed that a one-hour, three times a week exercise program resulted in both improved spinal curvature and self-esteem.
  • Among two groups of young adults with rounded shoulder posture, researchers found that shoulder stabilization and shoulder stretching exercises (40 mins, three times a week for four weeks) benefited patients in different ways. This suggests that combining these exercises may be the best approach to improve balance, strength, flexibility, and posture.
  • In another study that included young adults with rounded shoulder posture, researchers reported that patients experienced better results when scapular stabilization exercises were combined with abdominal bracing exercises.
  • Teenagers with forward head and protracted shoulder posture exhibited improved posture when specific neck and shoulder exercises were incorporated into their physical education program for sixteen weeks.

In 2008, the Neck Pain Task Force recommended exercise for the management of neck pain, including neck pain associated with a whiplash injury. A 2016 literature review published in the journal Spine added to that recommendation by noting that exercise is also effective for grade III whiplash and neck pain (and injury that includes loss of neurological function). Interestingly, the review did not find one form of exercise to be superior to another, suggesting that combining several forms of exercise may be the best way to achieve the most satisfying outcome for the patient.

Doctors of chiropractic are highly skilled in manual therapies, exercise training, and functional assessments – all of which have been found to successfully improve outcomes for patients with persistent neck pain. As with most conditions, prompt treatment yields the best results, so don’t delay in starting your chiropractic management program!

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Chiropractic Treatment for Wry Neck

19 Aug

Wry neck, also known as torticollis, is a painful condition in which the top of the head usually tilts to one side while the chin rotates to the opposite side. Torticollis can have several causes from infection (cold, flu, or otitis media, for example) to sleeping in a draft; however, the cause is usually unknown (idiopathic).

In a typical case, torticollis may resolve itself within four to six weeks, but with chiropractic care, cervical function can return to a more normal state much faster, often within a week. Chiropractic treatment for torticollis often includes stretching, in which manual cervical traction, spinal mobilization, and myofascial release techniques help to restore the lost range of motion and faulty posture. Once enough motion has been restored, a doctor of chiropractic may utilize spinal manipulation, which often hastens the recovery rate of torticollis. Chiropractors may also use physical therapy modalities and/or provide instruction on home-based exercises and other self-management strategies.

There’s a type of torticollis called congenital torticollis in which an infant is born with torticollis that either developed in utero or during the birth process. Current guidelines support prompt treatment for congenital torticollis versus taking a wait-and-see approach. One study found that treating infants with gentle manual therapy approaches at one month of age led to higher success rates than waiting until they were six months or older when substantially more care was needed to restore full range of motion with lower odds of success.

There is a less common but more serious type of torticollis called cervical dystonia, sometimes referred to as spasmodic torticollis, which is characterized by involuntary contraction of muscles in the neck that twist the head in a variety of directions. Cervical dystonia can occur at any age, but it’s more common among middle-aged women. While there is no known cure for the condition, there are case studies showing that cervical dystonia may respond to chiropractic treatment. In one such case study, a 59-year-old woman with an eleven-year history of cervical dystonia experienced a dramatic improvement in function (from 3/10 to 9/10 on a scale of 0 to 10, 10 being full function and 0 being no function) following a treatment regimen that included cervical spinal manipulation, reflex therapy, eye exercises, and vibration therapy.

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.